Clearing up an appeals decision
Mr. H, a police officer in a northern community, suffered post traumatic stress after being threatened while arresting a suspect in
July 2009. His police car and home were later vandalized, and he and his family left the community for their own safety.
The WSIB accepted a claim for traumatic mental stress and paid loss-of-earnings (LOE) benefits from August 2009 to July 2010. Mr. H
was cleared to return to work after participating in a psycho-trauma program assessment that found he had no psychological restrictions.
The assessment report noted that a successful return to work would be best by placement outside the region where the incident occurred
and recommended monitoring for the six months following his return to work.
Mr. H suffered two recurrences after he returned to work. The WSIB denied benefits for the recurrences and he appealed. The Appeals
Resolution Officer (ARO) allowed the appeal, finding Mr. H not fit for work from December 2011 to at least April 2012 and entitled to full LOE for that time. The ARO thought he did not have enough evidence to decide on further entitlements to LOE and directed the WSIB to
obtain more information to decide Mr. H’s capacity for employment and the employer’s willingness and ability to provide suitable work.
Mr. H spoke with the case manager about the ARO decision. He thought he was entitled to benefits for the period between the
termination of LOE in July 2010 up to the date the ARO reinstated benefits in December 2011. The case manager said the ARO decision
did not direct her to pay benefits retroactively. She suggested Mr. H write to the ARO for clarification. He wrote but did not receive a
Mr. H contacted the Commission, saying he had been dealing with the WSIB since 2010 and he still did not have benefits he believed
he was entitled to. He wrote that it “feels like I’m stuck in a hamster wheel just going around in circles.”
The Commission spoke with the assistant director, the ARO manager and the ARO to get clarification of the decision. The ARO
agreed to write Mr. H. The letter said, “In error, I did not provide specific direction as to the operations division authority to consider
benefits for this period…. It would be appropriate for the operations division to clarify the specific details as to work performed and
wage loss, if any from July 24, 2010 to December 2, 2011 and provide the parties a determination as to benefit entitlement, if any, for this
period.” The ARO documented the clarification on the claim file and then wrote to Mr. H, giving him an explanation of the direction given
to the operations division. The ARO also said he would continue to be involved in the file if there were any further related issues.